Treatment of Bee Sting Allergies – By Dr Aarn Huissoon, MB, PhD, FRCP, FRCPath
This article was written by the author and supported with a financial grant by ALK-Abello.
Allergic reactions to bee stings are relatively uncommon, but beekeepers have a higher chance of such reactions compared to the general population1. When they do occur they can be frightening and sometimes dangerous. This article will describe the different types of allergic reactions that can occur and how these can be treated.
Different types of reactions?
Doctors distinguish between two main types of allergic reaction: local reactions and systemic ‘whole body’ reactions. Both types are caused by the immune system overreacting to the venom. However, the effects, treatment and diagnostic tests are different.
This term describes swellings (sometimes very large) in the area that was stung. For instance, a sting on the finger can cause anything from a swollen finger to a hot, swollen arm; these are all local reactions. They typically take hours to develop and they settle down over many days. Local reactions are common, and while they can be very uncomfortable they are not life-threatening (unless you were stung in the mouth, for example, where the swelling could obstruct breathing). There are no tests to help confirm this diagnosis.
Systemic allergic reactions
These are immediate reactions, which can develop into anaphylaxis or allergic shock; a life-threatening emergency. Symptoms develop soon after the sting (usually within minutes) and progress quickly (see Table 1.) Up to a third of beekeepers suffer some degree of systemic reactions, but deaths are fortunately rare1. Allergy blood and skin tests can help with diagnosis, but they cannot tell you what will happen the next time you are stung.
Treatment of local reactions
These reactions usually do not need medical attention. A cold compresses or painkillers such as paracetamol or ibuprofen can help. Keeping a swollen limb elevated, e.g. in a sling, can also make it more comfortable. Antihistamines may slightly reduce the itching and swelling, and certainly do not do any harm. Sometimes antibiotics are prescribed in the mistaken belief that the swelling and heat are caused by an infection. While any skin wound, including a sting, can become infected, this usually takes a day or two to build up. If in doubt, do get medical advice. Only steroids can significantly speed up the healing of a large local reaction. The earlier these are used the better they work. So if you know that your stings always end up with large swellings, make sure you get to the doctors quickly to nip it in the bud. Steroids could make an infected sting worse, so it is important that a doctor or nurse looks at it first to decide.
Treatment of systemic allergic reactions1,2,3
Any symptoms other than local reactions could need urgent medical attention. They may be the first signs of anaphylactic shock, a life-threatening emergency. Most people recognise that itchy rashes or swelling lips are signs of allergy. But some people’s symptoms may be much less obvious. They may feel dizzy or feel their heart racing. They could feel short of breath or wheezy. Some people having anaphylaxis just describe a sense of ‘something seriously wrong inside’, without being able to pinpoint specific symptoms. If any of these symptoms occur after a sting, then:
- Dial 999 or 112 for a paramedic without delay, using the word ‘anaphylaxis’ (‘anna-fill-axis’).
- If the victim is known to be allergic to bee stings they should have an adrenaline injector device available. Use this as soon as it is clear that they are having a reaction. If there is none available, then the paramedics will have this. Adrenaline is more likely to be effective if given early.
- If antihistamines are available, and the victim is conscious and able to swallow safely, then give a double dose.
- If the victim is breathless, they should sit up. If they are dizzy or losing consciousness they should lie down with their legs raised. If they are unconscious, use the recovery position.
Preventing systemic allergic reactions
People who have had a severe allergic reaction have at least a 50/50 chance of having another if they are stung again1. So it makes sense to avoid the trigger (i.e. bees). Everyone who has had a serious allergic reaction, whatever the cause, should be referred to a specialist allergy clinic. Venom immunotherapy is a treatment for insect sting allergies which can reduce the likelihood of a future severe reaction. An allergy specialist can give you advice about the availability of this treatment and whether it would be suitable for you. Immunotherapy initially involves a course of weekly injections for about three months. During this time the dose of venom injected is slowly increased, ‘tricking’ your immune system into accepting it without reacting. After reaching the final dose, top-up injections are given monthly to complete a three-year course. There is a small risk of severe allergic reactions to the injections, so these have to be given in a specialist clinic.
- Krishna et al. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines. Clin Exp Allergy 2013; doi: 10.1111/j.1365- 2222.2011.03788.x
- Bilo MB et al. Self-medication of anaphylactic reactions due to Hymenoptera stings – An EAACI Task Force Consensus Statement. Allergy 2016; DOI: 10.1111/all.12908.
- https://www.hse.ie/eng/health/az/i/insect-stings/ (accessed 29th October 2020)